Heart Failure - Symptoms and Treatment Options

Heart failure affects approximately 4 to 5 million Americans annually. Developing slowly over time, heart failure occurs when the heart loses the muscle strength to pump enough blood throughout the body. Persons with heart failure may not even know their heart is pumping less efficiently until symptoms appear. Through recommended lifestyle modifications, medical treatments and surgical interventions, our physicians and surgeons can help heart failure patients lead a longer and fuller life.

What is Heart Failure?

Heart failure, frequently referred to as congestive heart failure, is a progressive disease building up over time; therefore symptoms and severity can range from mild to acute. However, heart failure is generally defined as a point in time “when the heart muscle doesn't pump as much blood as the body needs.” Heart failure is typically the result of heart attack or other heart diseases that damage the heart and is a serious health problem that can limit simple activities such as walking, bathing, or cooking.

Heart Failure Risk Factors and Symptoms

High LDL cholesterol levels – Overtime, high levels of LDL cholesterol (over 130 mg/dl) can add to plaque build-up and cause thickening and hardening of the arteries making the heart muscle work harder, increasing your risk for heart disease.

Heart biopsy – Heart muscle tissue samples help to find the cause of heart failure. Determining a diagnosis of myocarditis, virus or other causes of heart failure helps identify the best treatment course.

Right heart catheterization – The pressure levels in the heart, called hemodynamics, are checked through an invasive, non-surgical procedure. To perform a cardiac catheterization, a small hollow tube is inserted into a vein and advanced into the heart to check pressure levels.

Vasodilators, such as ACE-I; Angiotensin II Receptor Blockers; Hydralazine; and Nitrates, as well as, Beta Blockers, such as Coreg; and Lopressor improve quality of life by controlling symptoms and increase patient survival rates.

Diuretics such as Bumex or Lasix and Glycosides such as Digoxin and Digitalis are effective in providing symptomatic relief and are many times the first line of treatment to improve patient’s life quality.

Electrophysiology TreatmentsCardiac resynchronization therapy (CRT) is a relatively new treatment option available to select patients with heart failure-induced electrical abnormalities. Used in combination with medical therapy, CRT plays an important role in heart failure management. Even though the heart walls may be weak, CRT synchronizes the heartbeats. Restoring the heart’s mechanical sequence stimulates the heart walls to work rhythmically. Using implantable cardiac devices (ICD), such as pacemakers, electrophysiologists are able to treat heart failure patients who experience atrial fibrillation or those at risk for sudden cardiac death.

Surgical Therapies for Heart Failure

Revascularization

Coronary artery bypass graft (CABG) is performed to open blocked vessels or arteries and restore blood flow when a coronary artery has narrowed or become blocked. The affected vascular area is bypassed using a harvested blood vessel from another part of the body.

Angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), is a procedure done in the cardiac catheterization laboratory. PTCA opens partially blocked blood vessels to improve blood flow to the heart. A thin, flexible catheter tube is carefully inserted into the narrowed artery either through the femoral artery (groin) or brachial artery (arm). Once the catheter reaches the narrowing, a small balloon is inflated pressing fat and calcium deposits (plaque) against the wall of the vessel to improve blood flow. Many times a stent is used to hold open the vessel, helping prevent reclosure as well as strengthening the vessel wall to improve blood flow.

Conventional Surgery

Mitral valve surgery repairs or replaces the damaged mitral valve. The mitral valve regulates blood flow from the upper left heart chamber (atrium) into the lower left chamber (ventricle). Mitral valve regurgitation, caused by a damaged valve, is a serious condition, as blood backs up and leaks through the mitral valve between the upper and lower left chambers of the heart. Damaged valves, without repair, can cause enlargement of the left ventricle leading to heart failure.

Biventricular pacing with an ICD helps to synchronize contractions of the left and right ventricles, reduces mitral valve regurgitation, and decreases septal wall motion. Biventricular pacing, works similar to standard pacemakers. Standard pacemakers have two right heart stimulation leads, the biventricular pacemaker has a third lead, which goes through a vein in the back of the heart wall. Biventricular pacing simultaneously stimulates the heart's upper and lower chambers, providing timed electrical impulses.

Advanced Heart Failure Care

Left Ventricular Assist Device (LVAD)are mechanical devices that assist the heart’s pumping function. LVADs are one of the most innovative therapies for end stage heart failure. The devices are temporary for some and permanent for others. Used to treat patients with severe heart failure while waiting for a donor organ, LVADs can be a bridge-to-transplant or as destination therapy, long-term treatment for patients who are ineligible for a heart transplant. The pump is attached to a patient's own heart and is run by batteries. Natural circulation continues as the implant provides additional support, pumping blood throughout the body.

The HeartMate® is a fist-sized device, FDA approved, and made of titanium. It can be used for short-term bridge to transplantation, or indefinitely as destination therapy in patients who are not candidates for transplantation. HeartMate® is a portable device attached to a battery-containing external controller worn by the patient, similar to a shoulder bag. Patients can move about freely, exercise, and discharged from the hospital, allowing patients a greatly improved quality of life.

Heart Transplantation

California Pacific Medical Center has been actively performing heart transplants since 1984. Heart transplant surgery replaces a patient's diseased heart with a donor heart when all medical treatments or cardiovascular surgeries have failed. Approximately 2,300 heart transplants are performed each year in the United States. Transplantation is only considered when a patient’s heart failure no longer responds to other therapies and the patient’s health is otherwise good.
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California Pacific's Heart and Vascular Center

California Pacific's Heart and Vascular Center is supported by one of the best heart hospital/center networks in the USA, offering quality, comprehensive patient-centered cardiovascular care by a team of top heart surgeons and physicians with leading-edge technology. Serving the entire San Francisco Bay Area, including San Francisco and Marin County, as well as the entire Northern California region, our team has many of the best cardiovascular surgeons and physicians in California and the United States.
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